Benedito Pereira¹’³, Nathalia Soldi³, Patricia Jacob³, Beatriz Pinedo³, Larissa Fatel³, Ariane Garcia³, Juliana Antiqueira³, Stenio Zequi², Gustavo Guimarães², Germana Brito, Joubert Alves, Mariana Imanishe
¹ Nephrology, AC Camargo Cancer Center, Sao paulo, Brazil,
² Urology, AC CamargoCancer Center, Sao Paulo, Brazil and
³ Nephrology, Universidade Nove de Julho, Sao Paulo, Brazil
Kidney cancer in adults accounts for 2% to 3% of all malignancies. Recent studies have demonstrated the prevalence of various chronic non-neoplastic morbidities in patients with renal cancer, such as hypertension and diabetes. It is not clear whether the finding of histological changes not directly related to renal cell carcinoma predicts an unfavorable evolution of renal function or even only indicates alterations secondary to these morbidities with no evident clinical significance. Aims: To evaluate the non-oncological histological findings found in the descriptions of the pieces resulting from the partial nephrectomy of patients with localized renal carcinoma; to correlate these changes with the associated chronic morbidities in these patients.
A review of the histological reports found in the electronic medical record of 178 patients submitted to partial nephrectomy as primary treatment for a localized renal mass between 2009 and 2014. The following data were found in these reports: histological type of tumor, alterations found in the underlying tissue such as invasion of fatty and vascular tissue, presence of peri-tumor sarcomatous component, glomerular and non-neoplastic tubulo-interstitial changes. Patients who did not present nononcologic histological changes in the renal tissue resulting from nephrectomy were excluded and included only glomerular, vascular, and interstitial tubule changes in the peri-tumor tissue. We included clinical and associated laboratory and associated morbidity data.
Among the 178 patients who underwent partial nephrectomy to treat renal cancer, 11.79% (n = 20) presented other histological changes besides renal tumor. These non-neoplastic histological changes were found in 65% men and 35% women, with a mean age of 51.85 ± 12.20 years. Regarding surgery, 90% of patients underwent open-type surgery and only 10%. Among the associated diseases, it was verified that: 50% of hypertensive patients, 20% of diabetics, and 25% had cardiovascular diseases. Regarding the non-neoplastic histological alterations related to renal diseases, the glomerular alterations were seen in 20%, the tubular alterations in 10% and the interstitial alterations in 55%. Recognizing the predominance of chronic histological alterations in 55% (n = 17), we verified the predominance of chronic interstitial nephritis in 30%, chronic pyelonephritis in 10%, glomerulosclerosis in 20% and atherosclerosis in one patient. Other non-oncological findings were: renal micropapilloma in one case, 5% glomerular cyst, 15% interstitial fibrosis and one case with vascular congestion. The mean sCr before and after surgery in these patients was: 0.91 ± 0.23 mg / dL vs 0.90 ± 0.88 mg / dL and eGFR: 102.8 ± 23.8 ml / min vs 88, 0 ± 34.4 ml / min.
The main non-oncological histological findings were: chronic interstitial nephritis, glomerulosclerosis and interstitial fibrosis. Chronic interstitial nephritis presented a strong relation with male patients, overweight, hypertensive, smoking history and postoperative evolution with reduction of eGFR.